Long term external feeding of debilitated patients is perhaps best accomplished by means of a gastrostomy or a jejunostomy. As between the two, feeding through the stomach by means of a gastrostomy is easier than through the jejunum portion of the small intestine by means of a jejunostomy. This is because the stomach provides a reservoir for bolus feeding. There is also less chance of encountering problems with osmotic diarrhea. Some indications for gastrostomy are when a patient requires feeding, or venting an obstructed stomach.
Either of these procedures can be performed by conventional surgical techniques, i.e. open surgery. However, the invasiveness and trauma of such open procedures are well known. To avoid some of the problems inherent with open gastrostomy, a percutaneous endoscopic gastrostomy procedure has been developed. With the percutaneous endoscopic gastrostomy procedure, an endoscope is placed down the esophagus into the stomach interior. The endoscope is used to view the interior wall of the stomach as the introducer is inserted through the exterior body wall. Similarly, viewing of the interior wall of the stomach also facilitates placement of a tube by means of a tube introducer. While the interior stomach wall is thus viewed, the tube introducer is directly viewed in the stomach, but not in the peritoneal cavity.
In some situations, however, percutaneous endoscopic gastrostomy cannot be done. One such situation is where the patient needs a gastrostomy, but cannot undergo or has failed one due to an obstruction in the esophagus, e.g. because of pharyngeal or esophageal cancer. Another situation is where an endoscopist is not available. Still another is with patients with gastroesophageal reflux or a history of aspiration pneumonia. With these latter patients, a jejunostomy may be indicated. However, jejunostomy performed by using a technique similar to percutaneous endoscopic gastrostomy is not satisfactory because of the high complication rate. Accordingly, jejunostomy is traditionally placed by means of a laparotomy.
Attempts have also been made to perform jejunostomy laparoscopically using long needles carrying sutures through the body wall. See: Regan and Scarrow, "Laparoscopic Jejunostomy," Endoscopy, 1990, pp. 39-40. A needle holder, also passed through the body wall, is then manipulated to suture the jejunum to the abdominal wall and to pass the needles up through the body wall again. This procedure has disadvantages. Overall, the procedure is very difficult and time-consuming, especially when the body wall is thick. It requires a difficult technique of endoscopically-directed suturing of the small intestine and the abdominal wall using a long, straight needle. It also requires making another opening in the body wall to admit the needle holder. Still further, the feeding tube is placed through a stab wound, which may be large and less controlled.